Provider Demographics
NPI:1154835379
Name:BARRY, SHWONIA LEE (LSW)
Entity Type:Individual
Prefix:
First Name:SHWONIA
Middle Name:LEE
Last Name:BARRY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 EAKIN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2802
Mailing Address - Country:US
Mailing Address - Phone:269-870-3825
Mailing Address - Fax:
Practice Address - Street 1:2755 EAKIN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2802
Practice Address - Country:US
Practice Address - Phone:269-870-3825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker